Healthcare Provider Details

I. General information

NPI: 1619972783
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL HURLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 S CLIFF AVE SUITE 300
SIOUX FALLS SD
57105-1022
US

IV. Provider business mailing address

1417 S CLIFF AVE SUITE 300
SIOUX FALLS SD
57105-1022
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-8630
  • Fax: 605-322-8631
Mailing address:
  • Phone: 605-322-8630
  • Fax: 605-322-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number3798
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG88404
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6000342
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: